Family Planning & Preconception HIV testing

描述(由申请人提供)：计划生育和先入为主的艾滋病毒检测最近的疾病控制和预防中心人类免疫缺陷病毒(HIV)检测和先入为主的健康建议呼吁为育龄妇女提供例行的普遍艾滋病毒筛查。尽管有限，但有证据表明，在美国，多达50%的感染艾滋病毒的孕妇最初是通过产前筛查发现的。虽然这一发现率说明了促进产前筛查的努力取得了相对成功，但它也指出了先入为主的筛查做法的严重差距，因为在怀孕时不了解感染状况是早期发现的一个重要的“错失机会”。联邦第十条计划生育计划的受赠者，如申请组织，处于独特的地位，可以向种族和民族多样化、主要是低收入的患者群体提供常规的先入为主的艾滋病毒检测服务。然而，将常规的先入为主的艾滋病毒筛查提升到核心计划生育服务的地位的努力充其量也是喜忧参半。鉴于卫生保健提供者在将实践指南制度化和影响患者对服务的接受度方面发挥的关键作用，我们假设，整合一个简短的、基于证据的咨询模式可以对提供者和患者的先入为主的测试行为产生积极的变化。因此，我们建议调整卫生保健提供者提供的降低风险干预方案，它基于艾滋病毒预防的信息-动机-行为技能模型，并使用激励性访谈技术来传递降低风险的信息。拟议研究的具体目的是：1.与计划生育提供者和患者一起进行形成性研究，以了解基于先入为主的艾滋病毒检测在患者中的流行情况，确定提供者向患者提供艾滋病毒检测的频率，并确定艾滋病毒检测的信息、激励和行为技能促进者和障碍。2.修改选项干预的内容，以确保其针对信息、动机和行为技能方面的优势，相对于基于先入为主的艾滋病毒检测；我们将使用各种定量(调查)和定性(焦点小组、自由列表、半结构访谈)方法。我们还将探讨患者对先入为主的艾滋病毒检测的接受度，以及环境因素在多大程度上阻碍或促进艾滋病毒服务的提供。然后，拟议的研究将：3.进行一项试点研究，以评估将适应干预措施转化为计划生育环境的可行性；4.评估适应干预措施对计划生育环境中基于预先受孕的艾滋病毒检测的潜在影响。5.检查适应干预的效果在多大程度上受到个人(例如提供者、患者)和背景(例如临床环境)因素的调节。我们假设：a)在干预地点诊所提供服务的计划生育提供者的常规先入为主的艾滋病毒检测意向将显示出改善，以及b)在干预地点计划生育诊所的先入为主的艾滋病毒检测的比率将比持续护理标准的诊所更高。为了支持研究目标的实现，康涅狄格大学健康、干预和预防中心制定方案的关键成员黛博拉·康曼博士将担任联合调查员，包括第X条计划生育提供者和患者代表在内的社区咨询委员会将在拟议研究的所有阶段提供指导。此外，两名在各自费城艾滋病毒诊所成功整合计划生育服务的临床医生将担任临床顾问。干预内容和评估将作为复制手册进行记录。整合全国计划生育机构的干预措施将促进对艾滋病毒的常规先入为主的检测，将其作为治疗、护理和预防育龄妇女的门户。

DESCRIPTION (provided by applicant): Family Planning & Preconception HIV Testing Recent Centers for Disease Control and Prevention human immunodeficiency virus (HIV) testing and preconception health recommendations call for the provision of routine, universal HIV screening for women of reproductive age. Although limited, evidence suggests that up to 50% of pregnant women with HIV infection in the US are initially detected via prenatal screening. While this detection rate illustrates the relative success of efforts to promote prenatal screening, it also points to a critical gap in preconception screening practices, as unawareness of infection status at time of conception represents an important "missed opportunity" for early detection. Federal Title X Family Planning Program grantees, such as the applicant organization, are uniquely positioned to deliver routine preconception HIV testing services to a racially and ethnically diverse, and primarily low-income, patient population. Yet, efforts to elevate routine preconception HIV screening to the status of a core family planning service have met with mixed success at best. Given the critical role that health care providers play in institutionalizing practice guidelines and influencing patient receptivity to services, we hypothesize that the integration of a brief, evidence-based counseling model could effect positive changes in both provider and patient preconception testing behaviors. Thus, we propose to adapt the health care provider delivered Options risk reduction intervention, which is based on the Information-Motivation- Behavioral Skills model of HIV prevention and uses Motivational Interviewing techniques to deliver risk reduction messages. The specific aims of the proposed study are to: 1. Conduct formative research with family planning providers and patients to understand the prevalence of preconception-based HIV testing among patients, to determine how often providers offer HIV testing to their patients, and to identify the informational, motivational, and behavioral skills facilitators of and barriers to HIV testing. 2. Modify the content of the Options intervention to ensure that it targets deficits, and capitalizes on strengths, in information, motivation and behavioral skills, relative to preconception-based HIV testing; We will use various quantitative (survey) and qualitative (focus group, free list, semi-structured interview) methodologies. We will also explore patient receptivity to preconception HIV testing and the extent to which environmental-level factors impede or facilitate HIV service delivery. The proposed study will then: 3. Conduct a pilot study to assess the feasibility of translating the adapted intervention into family planning settings; 4. Assess the potential effect of the adapted intervention on preconception-based HIV testing uptake in family planning settings. 5. Examine the extent to which the effects of the adapted intervention are moderated by individual (e.g., provider, patient) and contextual (e.g., clinic environment) factors. We hypothesize that: a) family planning providers delivering services at intervention site clinics will show improvement in their routine preconception HIV testing intentions and b) rates of preconception HIV testing will be higher at intervention site family planning clinics when compared to clinics with continuing standard of care. To support attainment of the study aims, Deborah Cornman, PhD, a key member of the University of Connecticut's Center for Health, Intervention, and Prevention team that developed Options, will serve as a co-investigator, and a Community Advisory Board that includes Title X family planning provider and patient representatives will provide guidance in all phases of the proposed study. In addition, two clinicians who have successfully integrated family planning services at their respective Philadelphia HIV clinics will serve as clinical consultants. The intervention content and evaluation will be documented as a replication manual. Integration of the intervention at familyplanning agencies nationwide will promote routine preconception testing for HIV as the gateway to treatment, care, and prevention for women of reproductive age.